Effect of mycophenolate mofetil on progression of interstitial fibrosis and tubular atrophy after kidney transplantation: a retrospective study

Predicting outcomes after kidney transplantation: Can Pareto's rules help us to do so?

Kidney transplantation is the best option for kidney replacement therapy, even considering that most of the times the grafts do not survive as long as their recipients. In the Khalil et al's experience, published in this issue of the Journal, they analyze their second kidney graft survival and describe those significant predictors of early loss. This editorial comments on the results and put in perspec tive that most of the times, long-term graft survival could be inadvertently jeopardized if the immunosuppressive therapy is reduced or withdrawn for any reason, and that it could happen frequently if the transplant physician intends to innovate with the clinical care without proper evidence-based data.

EBV, CMV, and BK viral infections in pediatric kidney transplantation: Frequency, risk factors, treatment, and outcomes

BACKGROUND

Improved short- and long-term outcomes of kidney transplantation have been achieved over the past decades due to improved immunosuppression. This may have increased the risk for infections and, particularly, for the viral infections: cytomegalovirus (CMV), Epstein-Barr virus (EBV), and polyoma BK virus (BKV).

METHODS

A retrospective review of viremic CMV, EBV, and BKV infections in pediatric renal transplant recipients treated and followed by a national referral center over a 10-year period.

RESULTS

Sixty-seven patients (68% males) received 68 kidney grafts (62% from living donors) during the study period; the mean follow-up period was 5.2 ± 2.4 years. Twenty-seven viremic episodes were documented (CMV: 13, EBV: 6, BKV: 8) in 24 patients (35.2%). The median time (interquartile range) to viremia post-transplant was 11 (4-38) months. The viral infection rate was significantly higher in the years 2014-2015 than in previous years (61% vs. 29%, p = .017). Compared to patients who did not develop viremia, patients with viremias were younger at the time of transplantation, were more likely to receive thymoglobulin induction pre-transplant and to develop an acute rejection. Multiple logistic regression modeling identified transplant year and recipient's age as significant risk factors for viremia. Graft outcome and eGFR at the last follow-up was similar between patients who did and did not develop viremia.

CONCLUSIONS

Viral infections continue to be a major cause of morbidity in pediatric kidney transplant recipients. However, with close monitoring and prompt intervention, patient and renal outcomes remain favorable.

Incidence Rate and Predictors of Delayed Graft Function Among Adult Kidney Transplant Recipients at a Tertiary Care Hospital in Riyadh, Saudi Arabia

Background

Delayed graft function (DGF) is the most common early postoperative complication of renal transplantation. The occurrence of DGF can lead to both early and late devastating consequences on the allograft’s survival. The risk of developing this complication can increase with certain factors that are related to both the donor and the recipient. In the present study, we aimed to detect the incidence rate of DGF among patients attending a tertiary care hospital in Riyadh, Saudi Arabia, and to investigate potential predictors of DGF.

Materials and methods

This retrospective chart review was conducted at King Abdulaziz Medical City (KAMC), a tertiary care hospital in Riyadh, Saudi Arabia. The inclusion criteria were all patients, 18 years or older, who had renal transplantation from January 1, 2016, to March 31, 2020. Patients who had a second renal transplant, or renal transplantation in a different hospital and were followed up at KAMC were excluded. Patients’ medical records were accessed using the BESTCare electronic system to obtain the patients’ demographic data. A Chi-square test was used to test for the association between a predictor and a delay in graft function.

Results

A total of 344 patients were enrolled in the present study, approximately half of whom were males (56.6%, n=189). Around one-half (49.4%) were aged between 40 and 64 years. The most common cause of renal failure was hypertension, which was found in 117 (35%) patients, followed by diabetes mellitus (DM) in 94 (28.1%) patients. Most organ donors 258 (77.2%) were alive. A total of 23 (6.9%) participants developed DGF. Mycophenolate mofetil (MMF) was found to be significantly associated with DGF (P < 0.001). Those who took MMF (5.9%) had a significantly lower rate of DGF compared to those who did not (36.4%). A significantly higher rate of DGF was seen in patients whose transplants were taken from deceased donors (15.5%) compared to living donor transplants (3.9%). Gender, age, body mass index (BMI), recipient blood type, donor blood type, and cause of renal failure were not associated with DGF.

Conclusions

Only 6.9% of the study’s participants exhibited DGF. The observed rate was lower than the ones detected in the literature. Those who took MMF had a significantly lower rate of DGF compared to those who did not. Transplants of deceased donors (15.5%) showed a significantly higher rate of DGF. Larger multicenter studies are required to further investigate DGF in a region with a high prevalence of organ failure and a higher need for transplantations, such as Saudi Arabia.

Inflammation and renal fibrosis: Recent developments on key signaling molecules as potential therapeutic targets

Chronic kidney disease (CKD) is a major public health issue. At the histological level, renal fibrosis is the final common pathway of progressive kidney disease irrespective of the initial injury. Considerable evidence now indicates that renal inflammation plays a central role in the initiation and progression of CKD. Some of the inflammatory signaling molecules involved in CKD include: monocyte chemoattractant protein-1 (MCP-1), bradykinin B₁ receptor (B₁R), nuclear factor κB (NF-κB), tumor necrosis factor-α (TNFα), transforming growth factor β (TGF-β), and platelet-derived growth factor (PDGF). Multiple antifibrotic factors, such as interleukin-10 (IL-10), interferon-γ (IFN-γ), bone morphogenetic protein-7 (BMP-7), hepatocyte growth factor (HGF) are also downregulated in CKD. Therefore, restoration of the proper balance between pro- and antifibrotic signaling pathways could serve as a guiding principle for the design of new antifibrotic strategies that simultaneously target many pathways. The purpose of this review is to summarize the existing body of knowledge regarding activation of cytokine pathways and infiltration of inflammatory cells as a starting point for developing novel antifibrotic therapies to prevent progression of CKD.

Protective effect of mycophenolate mofetil on residual renal function in peritoneal dialysis patients: An open label feasibility study

AIM

This study aims to evaluate the safety of mycophenolate mofetil (MMF) and its effect on residual renal function (RRF) during peritoneal dialysis (PD).

METHODS

This is a prospective, randomized study comprising 60 PD patients. The patients were assigned either to the MMF group (MMF dosage: 1.0-1.5 g/day in two divided doses for 6 months, followed by a dose of 0.5-0.75 g/day for another 6 months) or to the control group. The patients close monitoring for 1 year. Variables related to residual renal function, including urine volume, measured glomerular filtration rate (GFR), and renal Kt/V, were measured at four time points.

RESULTS

There were no significant changes in urinary protein excretion in either group (P > 0.05). The MMF group showed a significantly higher urine volume than the control group (955.38 ± 243.54 vs 786.15 ± 279.62 mL/day, P = 0.024). The renal kt/V was also significantly higher in the MMF group (0.59 ± 0.11 in MMF vs 0.50 ± 0.19 in control group, P = 0.032). There was significant difference in the renal measured GFR between the two groups at 6, 9 and 12 months (MMF vs control at 6 months, 6.14 ± 0.66 vs 5.58 ± 0.65 mL/min per 1.73m² , P = 0.003; at 9 months, 5.68 ± 0.80 vs 4.78 ± 0.75, P < 0.001; at 12 months, 5.44 ± 0.91 vs 4.43 ± 0.93, P < 0.001). MMF was well tolerated without any serious complications.

CONCLUSION

The use of MMF in PD patients tends to better preserve RRF.

Long-term health-related quality of life of living kidney donors: a single-center experience

PURPOSE

Over the last few years, the evaluation of the health-related quality of life (HRQoL) of living kidney donors (LKD) has become of particular interest. The present study sought to evaluate the physical and mental HRQoL after kidney removal. The clinical and paraclinical course of these patients was examined, and the impact of preoperative donor evaluation, donor nephrectomy, and surgical recovery was evaluated. These data were compared with reference data of the general population.

METHODS

Between 1998 and 2010, 72 living kidney donations were performed at our institution. To assess the HRQoL, two questionnaires-the Short Form 36 (SF-36) and a special LKD questionnaire-were sent to all 72 living donors. The records of the follow-up examinations of all 72 donors were retrospectively analyzed in order to assess the clinical and paraclinical data after kidney donation.

RESULTS

Out of 72 donors, 55 (76.4 %) responded to the questionnaires. There was no change in systolic and diastolic blood pressure during the 7-year follow-up (p > 0.05). Mild proteinuria (>150 mg/l) was observed in six cases. Kidney donors had a higher HRQoL compared to the general population with mean values of the physical and mental summation scale (PCS and MCS, respectively) being 51.3 (SD = 7.6) and 50.6 (SD = 8.1). Peri- or postoperative complications were associated with lower values for physical function and physical component summary (PCS) (p < 0.05).

DISCUSSION

Living donor kidney transplantation appears to be safe for donors. The HRQoL is excellent. To ensure a positive outcome for donors, a good clinical evaluation of potential donors is essential.